Intervention Review

Amantadine and rimantadine for influenza A in adults

  1. Tom Jefferson1,*,
  2. Vittorio Demicheli2,
  3. Carlo Di Pietrantonj3,
  4. Daniela Rivetti4

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 25 APR 2008

DOI: 10.1002/14651858.CD001169.pub3

Database Title

Additional Information

How to Cite

Jefferson T, Demicheli V, Di Pietrantonj C, Rivetti D. Amantadine and rimantadine for influenza A in adults. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD001169. DOI: 10.1002/14651858.CD001169.pub3.

Author Information

  1. 1

    The Cochrane Collaboration, Vaccines Field, Roma, Italy

  2. 2

    Regione Piemonte - Azienda Sanitaria Locale ASL AL, Health Councillorship - Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Torino, Piemonte, Italy

  3. 3

    Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Alessandria, Piemonte, Italy

  4. 4

    Servizio di Igiene e Sanita' Pubblica, ASL 19 Asti, Public Health Department, Asti, Italy

*Tom Jefferson, Vaccines Field, The Cochrane Collaboration, Via Adige 28a, Anguillara Sabazia, Roma, 00061, Italy. jefferson.tom@gmail.com. jefferson@assr.it.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Amantadine hydrochloride (amantadine) and rimantadine hydrochloride (rimantadine) have antiviral properties, but they are not widely used due to a lack of knowledge of their potential value and concerns about possible adverse effects.

This review was first published in 1999 and updated for the fourth time in April 2008.

Objectives

The objective of this review was to assess the efficacy, effectiveness and safety ('effects') of amantadine and rimantadine in healthy adults.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 1), MEDLINE (1966 to April Week 4, 2008), EMBASE (1990 to April 2008) and reference lists of articles.

Selection criteria

Randomised and quasi-randomised studies comparing amantadine and/or rimantadine with placebo, control medication or no intervention, or comparing doses or schedules of amantadine and/or rimantadine in healthy adults.

Data collection and analysis

For prophylaxis (prevention) trials we analysed the numbers of participants with clinical influenza (influenza-like-illness or ILI) or with confirmed influenza A and adverse effects. Analysis for treatment trials was of the mean duration of fever, length of hospital stay and adverse effects.

Main results

Amantadine prevented 25% of ILI cases (95% confidence interval (CI) 13% to 36%), and 61% of influenza A cases (95% CI 35% to 76%). Amantadine reduced duration of fever by one day (95% CI 0.7 to 1.2). Rimantadine demonstrated comparable effectiveness, but there were fewer trials and the results for prophylaxis were not statistically significant. Both amantadine and rimantadine induced significant gastrointestinal (GI) adverse effects. Adverse effects of the central nervous system and study withdrawals were significantly more common with amantadine than rimantadine. Neither drug affected the rate of viral shedding from the nose or the course of asymptomatic influenza.

Authors' conclusions

Amantadine and rimantadine have comparable efficacy and effectiveness in relieving or treating symptoms of influenza A in healthy adults, although rimantadine induces fewer adverse effects than amantadine. The effectiveness of both drugs in interrupting transmission is probably low. Resistance of influenza viruses to amantadine is a serious worldwide problem as shown by recent virological surveillances. Both drugs have adverse gastrointestinal (stomach and gut) effects, but amantadine can also have serious effects on the nervous system. They should only be used in an emergency when all other measures fail.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antiviral drugs amantadine and rimantadine for preventing and treating the symptoms of influenza A in adults

The drugs amantadine and rimantadine can both help prevent and relieve the symptoms of influenza A in adults, but amantadine has more adverse effects.

The flu can be caused by many different viruses. One type is influenza A, with headaches, coughs and runny noses that can last for many days and lead to serious illnesses such as pneumonia. Amantadine and rimantadine are antiviral drugs. The review of trials found that both drugs are similarly helpful in relieving the symptoms of influenza A in adults, but only when there is a high probability that the cause of the flu is influenza A (a known epidemic, for example). It is likely that neither drug will interrupt the spread of influenza A and by treating symptoms may encourage viral spread in the community by people who are feeling better but are still infectious. Resistance of influenza viruses to amantadine is a serious worldwide problem as shown by recent surveys. Both drugs have adverse gastrointestinal (stomach and gut) effects, but amantadine can also have serious effects on the nervous system. They should only be used in an emergency when all other measures fail.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Amantadine和Rimantadine用於治療成人A型流感(Influenza A)

雖然Amantadine hydrochloride(amantadine)和Rimantadine hydrochloride(rimantadine)都具有抗病毒的效用，但由於缺乏對於其好處與副作用的認知，以致於未被廣泛使用。這篇系統性回顧文章在1999年首次出版，並於2008年4月進行了第四次更新。

目標

評估Amantadine和Rimantadine用於健康成人的效力及安全性。

搜尋策略

我們檢索了Cochrane Central Register of Controlled Trials(CENTRAL)(Cochrane圖書館2008年第1期)、MEDLINE(1966年至2008年4月的第4週)、EMBASE(1990年至2008年4月)以及文章的參考文獻目錄。

選擇標準

我們收錄了比較Amantadine/Rimantadine與安慰劑、控制組藥物、或未經任何治療的效果差異，以及比較Amantadine/Rimantadine之劑量或治療時間表的隨機(randomised)與半隨機(quasirandomised)對照試驗。

資料收集與分析

針對研究預防效果的試驗，我們分析了產生類流感症狀、確診為A型流感，以及副作用的病人人數；而針對研究治療效果的試驗，我們則分析了平均發燒時間、住院天數以及副作用。

主要結論

Amantadine可預防25％類流感症狀(95％CI 13 �36％)和61％的A型流感(95％CI 35％ −76％)之發生，也可縮短一天的發燒期(95％CI 0.7 �1.2)。Rimantadine也具有類似的效果，但因為相關試驗的數量較少，因此關於預防方面的結果便不具統計意義。Amantadine和Rimantadine都會引起明顯的胃腸道副作用，而Amantadine比Rimantadine產生了更多中樞神經系統副作用以及脫離研究的例子；這兩者均無法影響病毒從鼻腔脫離的速度，亦或改變無症狀的流感病程。

作者結論

Amantadine和Rimantadine對於健康成人的A型流感，有著類似的緩解或治療流感症狀的效果，且Rimantadine產生的副作用較少；這兩種藥物在減少疾病傳播的效果可能不彰。此外，最近的病毒學調查顯示，Amantadine的抗藥性是個嚴重的世界性問題。這兩種藥物都會引起明顯的腸胃道副作用，且Amantadine亦可能會嚴重影響神經系統，因此它們只應在其他治療失敗後的緊急情況之下被使用。

翻譯人

本摘要由慈濟醫院陳迪詠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抗病毒藥Amantadine和Rimantadine用於治療成人A型流感Amantadine和Rimantadine兩者，對於預防及減輕成人的A型流感症狀都有效果，但Amantadine會產生較多的副作用。流感可能由許多不同的病毒造成。其中一類是A型流感，通常以持續數日的頭痛、咳嗽以及流鼻涕來表現，並有可能導致嚴重疾病，如肺炎。Amantadine和Rimantadine都是抗病毒藥，而這篇回顧文章顯示，當病人高度懷疑感染A型流感時 (如流行期間的感染)，使用Amantadine或Rimantadine對於減輕成人的A型流感症狀都有效果。然而，這兩種藥物都無法阻斷A型流感的傳播，反而更有可能發生具傳染力的病人因治療後症狀改善，而增加了群體間病毒的散播。最近的研究顯示Amantadine的抗藥性是個嚴重的世界性問題。這兩種藥物都會引起明顯的腸胃道副作用，且Amantadine亦可能會嚴重影響神經系統，因此它們只應在其他治療失敗後的緊急情況之下被使用。

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